Shelsey Johnson, MD
Fellow
Boston Medical Center
Boston, Massachusetts
Disclosure information not submitted.
Emily Sisson
Data Analyst
Boston University School of Public Health, United States
Disclosure information not submitted.
Christopher Sheldrick, PhD
Data Analyst
Boston University School of Public Health, United States
Disclosure information not submitted.
Vishakha Kumar, MD, MBA
Society of Critical Care Medicine
Mount Prospect, Illinois
Disclosure information not submitted.
Karen Boman
Business Analyst
Society of Critical Care Medicine, United States
Disclosure information not submitted.
Scott Bolesta, PharmD, FCCM
Professor
Nesbitt College of Pharmacy at Wilkes University
Wilkes Barre, Pennsylvania
Disclosure information not submitted.
Vikas Bansal, MPH, MBBS
Research Fellow
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Marija Bogojevic, MD,
Resident Physician
Montefiore New Rochelle Hospital, Minnesota, United States
Disclosure information not submitted.
Juan Pablo Domecq Garces, MD
Assistant Professor of Medicine
Mayo Clinic College of Medicine
North Mankato, Minnesota, United States
Disclosure information not submitted.
Amos Lal, MBBS, FACP (he/him/his)
Fellow, Critical Care Medicine
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Smith Heavner, PhD, RN (he/they)
Scientific Director
Critical Path Institute
Simpsonville, SC, United States
Disclosure information not submitted.
Sreekanth Cheruku, MD, MPH
Physician
University of Texas Southwestern Medical Center, United States
Disclosure information not submitted.
Donna Armaignac, CCNS, CCRN-K, PhD
Director Center Advanced Analytics; Director Best Practice Tele Critical Care
Baptist Health South Florida
Pompano Beach, Florida, United States
Disclosure information not submitted.
Harry Anderson, MD
Physician
Baptist Health South Florida, United States
Disclosure information not submitted.
Joshua Denson, MD
Physician
Tulane Medical Center, United States
Disclosure information not submitted.
Ognjen Gajic, MD
Professor
Mayo Clinic
Rochester, Minnesota, United States
Disclosure information not submitted.
Rahul Kashyap, MD, MBA,
Medical Director Research
Wellspan Health-York Hospital
York, Pennsylvania
Disclosure information not submitted.
Allan Walkey, MD (he/him/his)
Professor of Medicine
Boston University
Boston, Massachusetts, United States
Disclosure information not submitted.
Title: Variation in use of high-flow nasal cannula and non-invasive ventilation in COVID-19
Introduction: Despite critical care guidelines supporting the use of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in patients with acute respiratory failure from coronavirus disease of 2019 (COVID-19), concerns surrounding aerosolization of viral particles, and patient self-inflicted lung injury likely influenced use across hospitals. We aimed to describe hospital variation in use and clinical outcomes of HFNC and NIV for management of COVID-19.
Methods: Retrospective, observational study of adult patients hospitalized with COVID-19 who received supplemental oxygen between February 15th 2020 and April 12th 2021 across 102 international and United States-based hospitals using the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 registry. HFNC and NIV use were evaluated using multivariable adjusted hierarchical random effects logistic regression models.
Results: Among 13454 adults with COVID-19 who received supplemental oxygen, 8143 (60%) received nasal cannula/face mask only, 2859 (21%) received HFNC, 878 (7%) received NIV, 1574 (12%) received both HFNC and NIV with 3640 (27%) patients progressing to invasive mechanical ventilation. Hospital of admission contributed to 24% of the risk-adjusted variation in HFNC and 30% of the risk-adjusted variation in NIV. The median odds ratio of HFNC was 2.6 (95% CI 1.4, 4.9) and NIV was 3.1 (95% CI 1.2, 8.1) which implies that a patient admitted to one randomly selected hospital may have a 2.6 and 3.1-fold increased chance of receiving HFNC or NIV respectively, as compared to another randomly selected hospital. Among 5311 patients who received HFNC and/or NIV, 2772 (52%) did not receive invasive mechanical ventilation and survived to hospital discharge. Hospital-level use of HFNC or NIV were not associated with rates of invasive mechanical ventilation or mortality.
Conclusions: Hospital variation in use of HFNC and NIV for acute respiratory failure secondary to COVID-19 was large, and was not associated with progression to invasive mechanical ventilation or mortality.